Browsing by Author "Santiago, I"
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- An ontogenetic approach to gynecologic malignanciesPublication . Santiago, I; Gomes, A; Heald, ROntogenetic anatomy is the mapping of body compartments established during early embryologic development, particularly well demarcated in the adult pelvis. Traditional cancer surgery is based on wide tumour excision with a safe margin, whereas the ontogenetic theory of local tumour spread claims that local dissemination is facilitated in the ontogenetic compartment of origin, but suppressed at its borders in the early stages of cancer development. Optimal local control of cancer is achieved by whole compartment resection with intact margins following ontogenetic "planes". The principles embodied in this hypothesis are most convincingly supported by the results of the implementation of total mesorectal excision in rectal cancer, and more recently, by innovative surgical approaches to gynaecologic malignancies. The high resolution contrast of MR, accurately delineating pelvic fascial compartments, makes it the best imaging modality for gynaecologic cancer surgery planning following these principles, but requires interpretation of imaging anatomy from a different perspective. TEACHING POINTS: • Ontogenetic anatomy refers to mapping of embryologically determined body compartments. • Ontogenetic theory claims tumour growth is not isometrical, but rather compartment permissive. • Ontogenetic principles are highly supported by the outcome results of total mesorectal excision. • Innovative gynaecologic cancer surgery approaches based on ontogenetic theory show promising results.
- Anatomic variants, congenital anomalies and pathology of the extrahepatic bile ductsPublication . Santiago, I; Maciel, J; Coelho, L; Costa, J; de la Fuente, G; Loureiro, R; Marques, C; Reis, D; Alves, F; Tardáguila, F
- Cardiac tumorsPublication . Santiago, I; Portilha, M; Gonçalves, B; Rodrigues, H; Donato, P; Alves, F
- Choledocal cysts: spectrum of imaging findingsPublication . Santiago, I; Maciel, J; Loureiro, R; Ruivo, C; Portilha, M; Gonçalves, B; Dias, N; Cipriano, M; Alves, F
- CT and MR features of splenic diseasePublication . Portilha, M; Santiago, I; Brito, J; Semedo, L; Alves, F
- Duodeno-colic fistula as a rare presentation of lung cancer - surgical treatment of a stage IV oligometastatic lung diseasePublication . Nunes, V; Santiago, I; Marinho, R; Pires, D; Manso, RT; Gomes, A; Pignatelli, NINTRODUCTION: Rare adenosquamous carcinomas have no defined standard approach given their low incidence. They present with nonspecific imaging characteristics and are described as having worse prognosis than other lung malignancies, with greater likelihood of local invasion and early metastasis. PRESENTATION OF CASE: Male caucasian patient, 43 years, 26 pack-year smoking history, presented with watery diarrhea, early emesis and loss of 25% body weight (20kg) in four weeks. Colonoscopy identified a left colonic mass. Abdominal CT/ultrasound showed a large fistulous lesion between the 4th portion of the duodenum and left colon. CT showed a solid mass in the right upper lung lobe. Endoscopy and transthoracic biopsy were inconclusive. En bloc D3 and D4 duodenectomy, proximal enterectomy and left hemicolectomy were performed, with inconclusive histology of the specimen. Three months later, a right upper lung lobectomy with lymphadenectomy was performed, revealing an adenosquamous carcinoma of lung origin, R0, staged as pT2pN0pM1b. Six months later, a single dural metastasis in the left cerebellopontine angle was detected and resected, with subsequent holocranial radiotherapy and systemic adjuvant chemotherapy. Patient is currently with 18 months follow-up, in good general health and with no evidence of recurrent disease. DISCUSSION: There are no specific guidelines to treat oligometastatic adenosquamous lung carcinoma. Our approach was abdominal surgery as a life-saving procedure and, months later, oncological resection of primary lung tumor and metachronous metastasis to the brain. CONCLUSION: A systematic, patient-oriented, patient-shared, multidisciplinary approach is particularly relevant when dealing with atypical presentations of rare diseases in young patients.
- Epithelial and submucosal lesions of the stomach: spectrum of CT findingsPublication . Santiago, I; Maciel, J; Canelas, A; Seco, M; Graça, B; Gonçalves, B; Dias, N; Cipriano, M; Alves, F
- Gastric GIST mimicking adenocarcinomaPublication . Gomes, A; Rocha, R; Manso, RT; Jonet, M; Santiago, I; Aleluia, C; Nunes, V
- High-risk features in potentially resectable colon cancer: a prospective MDCT-pathology agreement studyPublication . Santiago, I; Rodrigues, E; Germano, A; Costa, A; Manso, RT; Gomes, A; Leichsenring, C; Geraldes, VNeoadjuvant chemotherapy in potentially resectable high-risk Stage II and Stage III colon cancer has demonstrated promising results in the PRODIGE 22-ECKINOXE Phase II trial. Identification of adverse morphologic features, namely T3 with >5 mm extramural extension/T4 stages and/or N2, is fundamental and requires accurate noninvasive imaging. Our aim was to assess the value of optimized preoperative MDCT to stratify potentially resectable colon cancer patients for neoadjuvant therapy. METHODS: this is an observational prospective cross-sectional radiologic-pathologic agreement study. All patients with colon cancer referred to our Institution's Radiology department for preoperative MDCT staging between 01-10-2013 and 11-02-2015 underwent independent reading based on axial and multiplanar reconstruction images by 3 radiologists with 3, 6, and 20 years of experience in gastrointestinal radiology. T stage, extramural extension if T3 (≤5 mm or >5 mm), and N stage were recorded. Surgical specimens subsequently obtained underwent micro-pathologic analysis by a gastrointestinal pathologist with 9 years of experience in gastrointestinal pathology. Main outcome measures were sensitivity, specificity, PPV, NPV, AUROC, diagnostic accuracy, and interobserver agreement of optimized MDCT, and pathologic analysis of the surgical specimen considered the reference standard. RESULTS: 74 patients [43 males; median age 73 (45-89)] were eligible. MDCT sensitivity, specificity, PPV, NPV, AUROC, and diagnostic accuracy ranged between 42.9-76.2, 75.5-90.6, 55.2-76.2, 80.0-90.6, 0.67-0.83 and 0.76-0.86%, respectively, for the identification of T3 > 5 mm/T4 disease, with moderate interobserver agreement (0.49); and 8.3-33.3, 93.5-98.4, 20-66.7, 84.1-88.2, 0.51-0.65 and 0.80-0.86%, respectively, for the identification of N2 disease, with absent interobserver agreement (0.10). CONCLUSIONS: Specificity of MDCT in the stratification of patients for neoadjuvant therapy may be high enough to prevent overtreatment. However, it may lead to undertreatment in a meaningful proportion of patients. Observer performance may benefit from targeted training programs, given the variability and observer dependence of the results. Limitations include 4-slice MDCT equipment, time to surgery and lack of long-term outcome information based on imaging parameters per se.